How reliable is structured clinical history-taking in older adults with knee problems? Inter- and intraobserver variability of the KNE-SCI

J Clin Epidemiol. 2003 Nov;56(11):1030-7. doi: 10.1016/s0895-4356(03)00204-x.


Background and objectives: Clinical history and examination remain the cornerstones of diagnosis, prognosis, estimates of severity, and treatment selection in primary care for older adults presenting with knee pain. In this study we investigated the extent and cause of inter- and intraobserver variability of the clinical history using a structured, quantitative, clinical interview (KNE-SCI).

Methods: 58 patients aged 50 years and over with current knee pain were independently interviewed by two trained observers and again by one of these observers a month later.

Results: Interobserver and intraobserver variability were found to be generally low [median agreement beyond chance (kappa)=0.71 (range: -0.03-1.00) and 0.58 (range: -0.03-1.00), respectively]. However, 9 of the 57 items demonstrated high inter- and intraobserver variability: notably subjective reports of swelling and specific aspects of pain experience and functional limitation.

Conclusion: Structured interview can reliably quantify certain clinically relevant aspects of the clinical history in older adults with knee pain, including those felt to be indicative of osteoarthritis. Its usefulness requires further investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Data Interpretation, Statistical
  • Female
  • Humans
  • Male
  • Medical History Taking / methods*
  • Middle Aged
  • Observer Variation
  • Osteoarthritis, Knee / diagnosis*
  • Pain / etiology
  • Sensitivity and Specificity